Blue Cross and Blue Shield of Kansas City

Role Description The Lead Data Engineer analyzes, develops, and maintains complex logical data designs in support of corporate and customer information system requirements. Through proper data design and governance, this role maintains and monitors the use of standards and procedures and the integration of systems. This individual contributes to the enterprise architecture as a representative of data design and governance. Our ideal candidate uses expert specialist skills and knowledge to define and deliver data solutions and to contribute to the development and implementation of IT plans in line with the overall strategy of IT and the business. - Provides vision, leadership, and strategic direction on data management and enterprise information management and leads & coaches junior Data Engineers. - Defines, develops, and delivers consistent information and data standards, methodologies, guidelines, best practices, and approved modeling techniques on data/information management, data quality, and data governance. - Designs enterprise data architecture, including conceptual architectures for solution strategies, for data stores supporting transactional processing, data warehouses, operational data stores, data marts, and analytics. - Provides assistance and guidance to the development team regarding data model, SQL, and Stored procedures, including code review of complex SQL and Stored procedures and performance tuning as needed by development teams. - Develops data models as required by project teams. - Collects, maintains, and publishes corporate metadata related to the modeling in an enterprise asset repository. - Simplifies the existing data architecture and data architecture SDLC process, delivering reusable services and cost-saving opportunities in line with the policies and standards of the group. - Utilizes skills with the appropriate tools and business requirements to model entity relationships, multi-dimensionality, subject areas, state transitions, data flows and integrations, and reference data. - Leads the design, development, implementation, and maintenance of complex data systems and solutions ensuring technology solutions are in alignment with data architecture principles and target state. - Creates and maintains accurate, complete, and consistent governed conceptual, logical, and physical data models with lineage and implementation traceability metadata. - Responsible for source to target mapping where business rules are clearly documented and defined. Qualifications - Bachelor’s degree in Computer Science, Information Systems, Engineering, or a related field. - 7 years’ experience with data warehousing, including 5 years’ experience with relational modeling. - 7+ years of SQL development. - Experience with DLM and Enterprise Platforms for managing data movement. - Thorough understanding of the insurance industry (including claims processes, how attribution works, and the core business concepts of insurance). - Understanding of Scrum and Agile development practices. - Proven data governance and information management experience. - Strong interpersonal communication and follow-through skills and demonstrated initiative in autonomous environments. - Experience with database technologies (e.g., SQL, NoSQL, Snowflake, and Data Lake design). - Experience with ETL and other business intelligence tools. - Experience analyzing, organizing, and preparing data for use through the development of proprietary systems. - Experience designing multi-dimensional data models using Kimball Methodology. - Very effective interpersonal skills. Requirements - Master’s degree in Business Administration, Computer Science, Information Systems, or a related field of study. - 3 years’ experience in the healthcare industry. - 7+ years in IT. - Ability to lead, guide, motivate, and direct the work of others. - Experience with source to target mapping where business rules are clearly documented and defined. - Highly technical with hands-on experience using Python, or JVM language (Java, Scala, Clojure, or Kotlin). - Experience implementing, managing, and developing in Apache Airflow or other orchestration tools. - Experience implementing data solutions in a major cloud provider (Azure, AWS, or GCP). - Experience with semi-structured formats (Avro, Parquet, ORC, YAML, JSON, or XML). - Experience with MDM Implementation. - Experience with MDM Tools (Informatica, Profisee, or similar). - Experience implementing Kafka, Schema Registry, and Kafka Streaming and/or Spark Streaming. - Experience with Microsoft Azure. - Experience with Apache Airflow and Celery. - Experience with Docker, Kubernetes, and Terraform. - Experience with Snowflake or Synapse. - Experience with Informatica IDQ, EDC, IICS, and Axon. - Experience with Scala, Python, and Java. - Experience with NodeJS and React. - Experience with Azure Data Lake Storage Gen2. - Experience with cloud platforms such as Azure, AWS. Benefits - Highly competitive total rewards package, including comprehensive medical, dental, and vision benefits as well as a 401(k) plan that both the employee and employer contribute. - Annual incentive bonus plan based on company achievement of goals. - Time away from work including paid holidays, paid time off, and volunteer time off. - Professional development courses, mentorship opportunities, and tuition reimbursement program. - Paid parental leave and adoption leave with adoption financial assistance. - Employee discount program. Company Description Blue Cross and Blue Shield of Kansas City is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to, among other things, race, color, religion, sex, sexual orientation, gender identity, national origin, age, status as a protected veteran, or disability.

Role Description Utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual’s health needs through communication and available resources to promote optimal, cost-effective outcomes. Transplant only: Provides prior authorization for, coordinates, and individually manages all member transplants. Acts as an internal and external customer resource for interpretation of transplant benefits and transplant-related claim adjudication. Serves as a company expert on current and future transplant types. The candidate for this position must reside in the Kansas City metropolitan area. - Completes member assessments by collecting and analyzing information across the seven domains of health. - Develops and implements individualized care plans with appropriate interventions in a culturally sensitive way. - Monitors effectiveness of plan of care by gathering sufficient information from relevant sources. - Acts as liaison between member, employer, providers, support system and BlueCross BlueShield of Kansas City. - Prioritizes interventions based on clinical need and readiness to change. - Educates and works with members at different educational and health literacy levels. - Meets individual quality performance standards and annual targets for program performance. - Schedules time effectively and works with minimal supervision. Qualifications - Associate degree in nursing. - 3 years full-time direct patient care clinical experience in either transplant, oncology or medical/surgical. - Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public. - Ability to define problems, collect data, establish facts, and draw valid conclusions. - Thorough knowledge of URAC and NCQA® guidelines and state and federal regulations. - Valid and active Registered nurse (RN) in Missouri and Kansas. - Case Management Certification within 3 years of hire date or within 3 years of transfer to Case Management role/department. Requirements - Provides prior authorization of the transplant and manages individual member cases. - Educates members, providers, and other customers regarding transplant benefits. - Ensures proper payment of pre-transplant, transplant, and post-transplant claims. - Accurately reports potential high cost members and tracks costs on members currently undergoing transplants. - Serves as transplant information source for other departments of the company. Benefits - Highly competitive total rewards package, including comprehensive medical, dental and vision benefits. - 401(k) plan that both the employee and employer contribute. - Annual incentive bonus plan based on company achievement of goals. - Time away from work including paid holidays, paid time off and volunteer time off. - Professional development courses, mentorship opportunities, and tuition reimbursement program. - Paid parental leave and adoption leave with adoption financial assistance. - Employee discount program.

Guided by our core values and commitment to your success, we provide health, financial and lifestyle benefits to ensure a best-in-class employee experience. Some of our offerings include: - Highly competitive total rewards package, including comprehensive medical, dental and vision benefits as well as a 401(k) plan that both the employee and employer contribute - Annual incentive bonus plan based on company achievement of goals - Time away from work including paid holidays, paid time off and volunteer time off - Professional development courses, mentorship opportunities, and tuition reimbursement program - Paid parental leave and adoption leave with adoption financial assistance - Employee discount program Job Description Summary: The Senior Provider Business Analyst plays a critical leadership role in advancing the strategy, systems, and operations that support provider credentialing, contracting, and lifecycle management. This individual serves as a trusted advisor and subject matter expert, driving cross-functional initiatives that align provider processes with enterprise goals, regulatory requirements, and industry best practices. With a deep understanding of healthcare/payer operations, credentialing standards (e.g., NCQA, CMS, BCBSA), and provider data systems, the Senior Analyst leads the design and optimization of workflows, system configurations, and data governance strategies. This role partners closely with Provider Contracting, Reimbursement, IT, Compliance, and vendors to ensure provider lifecycle systems are scalable, compliant, and efficient. Job Description - Lead and oversee large project implementations and upgrades of provider management platforms, ensuring seamless integration and alignment with organizational goals. - Manage Business Data Governance Committee to instill data standards and accuracy - Serve as a subject matter expert (SME) on provider management platforms, credentialing/contracting/directory data/provider relations workflows, and regulatory standards. - Collaborate with cross-functional teams to design and implement scalable solutions that improve provider onboarding, data integrity, and operational efficiency. - Manage vendors to adhere to SLA and performance measures to ensure compliance. - Apply strong analytical and problem-solving skills to identify, analyze, and resolve complex business issues related to provider management. - Monitor production and test environments, proactively identifying and resolving issues to ensure optimal system performance. - Write efficient, insightful reports utilizing SQL to inform decision-making and monitor key performance indicators. - Mentor junior analysts and contribute to the development of department policies, procedures, and training materials. - Drive continuous improvement initiatives by leveraging data insights, stakeholder feedback, and industry trends. - Support NCQA or URAC Accreditation efforts by maintaining high standards for provider network, data, and credentialing. Minimum Qualifications - Bachelor’s degree or an equivalent combination of education and experience. - 5+ years of experience in business analysis within a payer, with a focus on credentialing and provider data management. - Expert with sPayer or other payer provider lifecycle/credentialing/contracting systems, CRM, and quality accreditation processes. - Efficient report writer utilizing SQL - Experience maintaining NCQA or URAC accreditation - Proven ability to lead cross-functional initiatives and influence stakeholders at all levels. - Strong analytical, problem-solving, and communication skills. - Large project implementation or upgrade of provider management platforms. - Proficiency in Microsoft Office applications. Preferred Qualifications - Master’s Degree in Information Systems, Data Management, Healthcare Administration or a related academic field - Experience with Facets Claims software Blue Cross and Blue Shield of Kansas City is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to, among other things, race, color, religion, sex, sexual orientation, gender identity, national origin, age, status as a protected veteran, or disability.

Guided by our core values and commitment to your success, we provide health, financial and lifestyle benefits to ensure a best-in-class employee experience. Some of our offerings include: - Highly competitive total rewards package, including comprehensive medical, dental and vision benefits as well as a 401(k) plan that both the employee and employer contribute - Annual incentive bonus plan based on company achievement of goals - Time away from work including paid holidays, paid time off and volunteer time off - Professional development courses, mentorship opportunities, and tuition reimbursement program - Paid parental leave and adoption leave with adoption financial assistance - Employee discount program Job Description Summary: The Provider Network Strategist plays a critical role in translating complex healthcare concepts into clear, actionable guidance that supports strategic decision making. Leveraging extensive experience across network strategy, value based programs, provider relations, and multiple lines of business, this role connects organizational objectives with practical steps and structured deliverables. The analyst works closely with diverse stakeholders to gather insights, clarify expectations, and maintain alignment throughout initiatives. By simplifying complexity, communicating effectively with both technical and non-technical audiences, and understanding the broader healthcare business landscape, the Provider Network Strategist ensures clarity, consistency, and strategic coherence across the organization. Job Description • Synthesize complex concepts across network strategy, value-based programs, and operations into clear, actionable guidance for diverse audiences. • Translate organizational goals into structured workplans, outlining key components, decision points, dependencies, and expected outcomes. • Coordinate cross functional alignment by gathering inputs, clarifying expectations, and ensuring stakeholders remain informed and connected throughout the initiative. • Develop polished, decision ready materials (briefs, presentations, summaries, frameworks) that clearly convey status, implications, and recommendations. • Identify risks, gaps, and interdependencies early and propose pragmatic paths to maintain momentum and consistency across efforts. • Frame and facilitate discussions that drive clarity—surfacing assumptions, confirming scope, and aligning on next steps without formal authority. • Apply knowledge of all major lines of business (Commercial, JAA, FEP, Medicare Advantage, Medicaid) to ensure solutions are feasible and appropriately tailored. Minimum Qualifications - Bachelor’s degree in Business, Economics, Information Systems, Healthcare Administration, or related field, or an equivalent combination of education and experience - Five or more years of experience in network strategy, provider relations, healthcare operations, value-based programs, or a closely related discipline - Proven ability to communicate clearly with both technical and non-technical stakeholders through written summaries, presentations, and status updates - Experience with breaking complex concepts into clear, manageable components for diverse audiences - Experience coordinating across multiple stakeholders to gather information, clarify expectations, and maintain alignment throughout an initiative - Experience with all health insurance lines of business, including but not limited to: Commercial, JAA, FEP, Medicare Advantage, Medicaid - Understanding of business needs and objectives in the healthcare industry - Excellent written and verbal communication skills, with the ability to create polished, professional deliverables - Strong conceptual thinking skills with the ability to understand broad organizational objectives and connect them to practical steps and actions Preferred Qualifications - Master's degree in related field - 10 or more years of experience in network strategy, provider relations, healthcare operations, value-based programs, or a closely related discipline - Experience shaping frameworks, roadmaps, or narratives that help teams understand priorities, decision points, and impacts - Experience with synthesizing input from multiple sources to form cohesive, actionable recommendations - Experience supporting leadership through clear summaries, decision-ready materials, and structured messaging - Skilled at anticipating operational considerations and identifying dependencies, risks, or gaps early in the process - Familiarity with healthcare contracting, reimbursement structures, and value-based care concepts Blue Cross and Blue Shield of Kansas City is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to, among other things, race, color, religion, sex, sexual orientation, gender identity, national origin, age, status as a protected veteran, or disability.

Guided by our core values and commitment to your success, we provide health, financial and lifestyle benefits to ensure a best-in-class employee experience. Some of our offerings include: - Highly competitive total rewards package, including comprehensive medical, dental and vision benefits as well as a 401(k) plan that both the employee and employer contribute - Annual incentive bonus plan based on company achievement of goals - Time away from work including paid holidays, paid time off and volunteer time off - Professional development courses, mentorship opportunities, and tuition reimbursement program - Paid parental leave and adoption leave with adoption financial assistance - Employee discount program Job Description Summary: The Customer Advocate position is responsible for responding to a variety of inquiries from members and their dependents, hospitals, providers, attorneys and agents. The incumbent will need to interpret multiple contracts in response to benefit and claim inquiries. Researches membership database and billing history to resolve membership issues. Job Description EACH DUTY AND RESPONSIBILITY MUST BE PERFORMED IN ACCORDANCE WITH INDIVIDUAL PERFORMANCE SCORECARD INQUIRY AND QUALITY STANDARDS. - Provides a high degree of customer service including receiving and responding to telephone calls, letters or walk-in customers. - Educates and works with members at different health literacy levels with cultural sensitivity. - Enters record of inquiries and related correspondence in computerized tracking system. - Researches applicable medical policy and corporate, divisional, and department policies and procedures. Utilizes information, claims data, and membership records to resolve issues independently or with minimal assistance, when possible within first call - Fully responsible for proactively maintaining knowledge based (i.e. start-up notes, emails, Blue Help updates, etc.) - Maintains confidentiality of all regulated information in compliance with state and federal laws. - Exemplifies professionalism by effectively using proper grammar and spelling when composing verbal and written correspondence that is customer centric, compliant, and adapted to audience. - Recognizes trends or common issues and raises to leadership as necessary. Provides solution options as appropriate. - Recognizes and uses time management techniques appropriately to manage competing projects and priorities to meet customer needs and deliver on commitments in a timely manner. - Delivers positive customer and member experience on a consistent basis - For FEP positions must complete additional FEP training program for FEP system and procedures. - Provides resolution with a service level that ensures members and customers feel valued and understood Minimum Qualifications - High school diploma or general education degree (GED). - 2 years of previous customer service, member services, or claims processing experience; or any combination of required education and experience - Advanced Keyboarding Knowledge - Intermediate knowledge of Microsoft Office Preferred Qualifications - Associates degree from college or technical school. - Previous experience with on-line customer service applications - Medical terminology and ICD/CPT coding knowledge - Experience taking Blue KC member calls Blue Cross and Blue Shield of Kansas City is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to, among other things, race, color, religion, sex, sexual orientation, gender identity, national origin, age, status as a protected veteran, or disability.

Guided by our core values and commitment to your success, we provide health, financial and lifestyle benefits to ensure a best-in-class employee experience. Some of our offerings include: - Highly competitive total rewards package, including comprehensive medical, dental and vision benefits as well as a 401(k) plan that both the employee and employer contribute - Annual incentive bonus plan based on company achievement of goals - Time away from work including paid holidays, paid time off and volunteer time off - Professional development courses, mentorship opportunities, and tuition reimbursement program - Paid parental leave and adoption leave with adoption financial assistance - Employee discount program Job Description Summary: Under general supervision, assesses claim information, references contracts and performs calculations and other functions to accomplish the processing and payment of insurance claims of a complicated or non-routine nature. Interprets contract information and communicates with outside parties to obtain information and coordinate coverage. Performs claim research and adjustments. Job Description EACH DUTY AND RESPONSIBILITY MUST BE PERFORMED IN ACCORDANCE WITH INDIVIDUAL PERFORMANCE SCORECARD PRODUCTION AND QUALITY STANDARDS. - Successfully completes all training programs as required for the level. - Processes claims for two products or claim types (dental, hospital, medical, ITS, FEP). - Performs research and adjustment functions for claims. - Perform special projects (e.g., complex accumulator reconsiderations, New Directions). - Responds to written inquiries from internal and external customers as business needs dictate. - Sets up deducts, CLOV table entries, and other assigned finance functions. - For FEP positions, processes all deferrals for FEP or edit corrections in computerized claims system. - Performs complex FEP transactions (e.g., FEP Direct DDE, FEP Retro-enrollment, Out of Balance) and member appeals. Minimum Qualifications - High school diploma or general education degree (GED). - 2 years of previous customer service, member services, or claims processing experience; or any combination of required education and experience. - Advanced Keyboarding Knowledge - Intermediate knowledge of Microsoft Office Preferred Qualifications - Knowledge of FACETS and/or other computerized claims processing system as applicable (FEP). - Associates degree from college or technical school Blue Cross and Blue Shield of Kansas City is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to, among other things, race, color, religion, sex, sexual orientation, gender identity, national origin, age, status as a protected veteran, or disability.